Backer V, Groth S, Dirksen A, Bach-Mortensen N, Hansen K K, Laursen E M, Wendelboe D
Dept of Medicine, State University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur Respir J. 1991 Oct;4(9):1093-100.
The purpose of this investigation was to study factors of importance for the degree of bronchial responsiveness and, furthermore, to evaluate the sensitivity, specificity and predictive value of a bronchial challenge test with histamine for the diagnosis of asthma in 495 randomly selected children and adolescents, aged 7-16 yrs, from Copenhagen, Rigshospitalet. Detailed history about allergic symptoms, physical examination and bronchial histamine challenge tests were performed at the out-patient clinic. Asthma, atopic disease and height were found to be of great importance for the degree of bronchial responsiveness, whereas the age, sex and smoking habits were of no significance. The percentage of asthmatics with bronchial hyperresponsiveness, i.e. sensitivity to the test, increased towards 100% on inhaling increasing concentrations of histamine, but this was accompanied by a decrease in specificity and predictive values of positive test in regard to the diagnosis of asthma. However, lower concentrations of histamine may be preferable in order to distinguish between asthma and non-asthma in population samples, as inhalation of 2.4 mg.ml-1 and provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) provided an acceptable sensitivity (57%), specificity (98%), and predictive value of a positive test (60%). We conclude that as regards the diagnosis of asthma, a low predictive value confirms that the bronchial challenge test plays only a supplementary, but valuable, role in detecting the disease in population samples.
本研究的目的是探讨对支气管反应程度具有重要意义的因素，此外，还对来自哥本哈根里格霍斯医院的495名7至16岁随机选取的儿童和青少年进行组胺支气管激发试验诊断哮喘的敏感性、特异性和预测价值进行评估。在门诊进行了关于过敏症状的详细病史、体格检查和支气管组胺激发试验。发现哮喘、特应性疾病和身高对支气管反应程度具有重要意义，而年龄、性别和吸烟习惯则无显著意义。随着吸入组胺浓度的增加，支气管高反应性哮喘患者的比例（即试验敏感性）朝着100%增加，但这伴随着试验阳性在哮喘诊断方面的特异性和预测价值的降低。然而，为了在人群样本中区分哮喘和非哮喘，较低浓度的组胺可能更可取，因为吸入2.4mg/ml组胺和使一秒用力呼气量（FEV1）下降20%的激发浓度（PC20）可提供可接受的敏感性（57%）、特异性（98%）和试验阳性的预测价值（60%）。我们得出结论，就哮喘诊断而言，低预测价值证实支气管激发试验在人群样本中检测该疾病时仅起辅助但有价值的作用。
